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Elderly Drivers with Cognitive Impairment

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181. Adult Type 1 diabetes mellitus

Excellence (NICE) NG17 “Type 1 diabetes in adults: diagnosis and management” guideline, published in 2015. Using this National Clinical Guideline This National Clinical Guideline applies to adults (aged 18 years and older) with type 1 diabetes in Ireland. It does not apply to children living with type 1 diabetes, adults living with type 2 diabetes or individuals living with monogenic (or other rarer forms of) diabetes. This National Clinical Guideline is relevant to all healthcare professionals working (...) , see the full guideline (https://www.nice. org.uk/Guidance/NG17/Evidence) Table 3: Members of the NICE Guideline Development Group Name Job title and affiliation Stephanie Amiel Professor of Diabetic Medicine, King’s College London Augustin Brooks Consultant Diabetologist, Bournemouth Hospital Arthur Durrant Patient member Michael Flynn Consultant Physician, Kent and Canterbury Hospital Roger Gadsby Visiting Professor, Institute of Diabetes in Older People, University of Bedfordshire; GP

2018 National Clinical Guidelines (Ireland)

182. ECDC tool for the prioritisation of infectious disease threats

could be characterised as a hotspot of emerging infectious diseases [4]. Future global changes such as climate change, population growth, increasing mobility and ageing population can reasonably be expected to further affect these emerging risks [5-7]. Consequently, there is a need for new methodologies which can be used to prioritise and rank infectious disease threats for preparedness planning purposes in order to mitigate the impact of these threats [8]. Numerous different approaches have been (...) benefit of bringing together stakeholders in the decision-making process. Multi-criteria decision analysis for ranking disease threats Expert opinion is an important information source when empirical data are lacking or uncertain. It is, however, undesirable to base planning on the input from just a few experts, even if they are highly qualified, as cognitive bias can never be completely ruled out. One way to mitigate bias is to pool expert opinion. There is a rapidly growing body of literature

2017 European Centre for Disease Prevention and Control - Technical Guidance

183. Sapropterin (Kuvan) - phenylketonuria (PKU)

in high blood phenylalanine levels that can cause permanent brain damage in children and can impair cognitive and neuropsychological functioning in adults. Maternal PKU can result in non-viable pregnancies, birth defects and lifelong learning disability in the offspring. • Patients with phenylalanine blood levels above the target range while adhering to a phenylalanine restricted diet have no alternative treatment options. Most patients are unable to adhere to the diet all of the time as most foods (...) to a phenylalanine restricted diet alone in adult and paediatric patients of all ages with PKU for the treatment of HPA in patients who have been shown to be responsive to sapropterin treatment. The comparator appears to be appropriate. The patient population considered consists of a combination of 0 to 18 year olds uncontrolled (elevated phenylalanine with symptoms) and partially controlled (phenylalanine within target range but with presence of symptoms) who are shown to be responsive to sapropterin treatment

2018 Scottish Medicines Consortium

184. Alectinib hydrochloride (Alecensa) - anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC)

(EORTC) Quality of Life Questionnaire -Core (QLQ-C30) and the supplemental lung cancer module (QLQ-LC13). Analyses of EuroQoL 5 Dimension (EQ-5D) were exploratory. 3 The EUnetHTA report notes that there was no difference between the groups in time to deterioration (TTD) for global health score, HR 0.72 (95% CI: 0.38 to 1.39); cognitive function, HR 0.85 (95% CI: 0.55 to 1.33); cough; chest pain, fatigue, pain in other parts and dyspnoea. 5 Other data were also assessed but remain commercially (...) with the crizotinib group: nausea (14% versus 48%), diarrhoea (12% versus 45%) and vomiting (7.2% versus 38%). Other adverse events reported at a lower frequency with alectinib were elevations of alanine aminotransferase (ALT) (15% versus 30%), aspartate aminotransferase (AST) (14% versus 25%) and gamma-glutamyltransferase (0.7% versus 6.6%), peripheral oedema (17% versus 28%), dizziness (7.9% versus 14%), dysgeusia (2.6% versus 19%), alopecia (0.7% versus 7.3%), visual impairment (1.3% versus 12%), blurred

2018 Scottish Medicines Consortium

185. Examining the Impact of Decriminalizing or Legalizing Cannabis for Recreational Use

. Moreover, among those studies that found increased use, the findings are not conclusive. For example, the National Survey on Drug Use and Health found an increase in the prevalence of cannabis use in the past 30 days for both those aged 18 to 25 and those 26 and older.(7) Among those 18- to 25-years-old, prevalence rates have increased from 21 per cent in 2006 to 31 per cent in 2014, and rates have increased from five per cent in 2006 to 12 per cent in 2014 among those 26 and older.(7) Similarly, three (...) for youth during their physical and mental development, where cannabis use has been found to impair reaction time, processing speed, concentration and other cognitive and psychomotor abilities, and to pose a risk of early onset of psychotic episodes for individuals predisposed to schizophrenia.(1;2) In efforts to better control who has access, who is distributing and who is benefiting from the sale of cannabis, the approach in some jurisdictions to regulating its use is to shift away from a prohibitive

2017 McMaster Health Forum

186. Developing a National Pain Strategy for Canada

found that the prevalence of chronic pain that was rated moderate to severe was 24% among those aged 65 to 74, and 30% among those aged 75 to 84.(12) The high and rising prevalence of chronic pain among older (and middle-aged) adults is troublesome for at least three reasons. First, chronic pain has been associated with the lowest quality of life compared to other chronic diseases, such as chronic heart or lung disease, and patients with chronic pain have double the risk of suicide compared (...) aim to strengthen health systems – locally, nationally, and internationally – and get the right programs, services and products to the people who need them. Authors Kerry Waddell, M.Sc., Co-lead Evidence Synthesis, McMaster Health Forum Kaelan A Moat, PhD, Managing Director, McMaster Health Forum John N. Lavis, MD PhD, Director, McMaster Health Forum, and Professor, McMaster University Funding The evidence brief and the stakeholder dialogue it was prepared to inform were funded by the Michael G

2017 McMaster Health Forum

187. Cannabis

the presence of active drugs in their systems. Samples from 1,097 drivers aged 20 to 50 years were analyzed and 7.3% of them tested positive for recent cannabis use. 28 Cannabis accounted for nearly half of the drugs detected in 2012. Data from a recent roadside survey in Ontario revealed that marijuana was the most common illegal drug present among young drivers. 29 According to the 2017 CCS, 39% of respondents aged 16 and older who had used cannabis in the past year reported driving within two hours (...) and municipal levels. 10 Driving while impaired by a drug, including cannabis, is an offence under the Criminal Code of Canada. Drivers who are impaired by drugs are subject to the same penalties as those impaired by alcohol. The government tabled Bill C-46 in April 2017 to strengthen the enforcement of impaired driving laws and also plans to enact this legislation in conjunction with the Cannabis Control Act. Currently, Canadians can legally access cannabis for medical purposes. Under the Marihuana

2018 Canadian Centre on Substance Abuse

188. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

in prediabetes and T2D. Obesity is a chronic disease, and a long-term commit- ment to therapy is necessary. 3. The hemoglobin A1C (A1C) target should be individ- ualized based on numerous factors such as age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia or adverse consequences from hypoglycemia, patient motivation, and adherence. An A1C level of =6.5% is considered optimal if it can be achieved in a safe and affordable manner, but higher targets may be appropriate (...) mechanisms of action. 11. Comprehensive management includes lipid and BP therapies and treatment of related comorbidities. 12. Therapy must be evaluated frequently (e.g., every 3 months) until stable using multiple criteria, includ- ing A1C, SMBG records (fasting and postprandial) or continuous glucose monitoring tracings, documented and suspected hypoglycemia events, lipid and BP values, adverse events (weight gain, fluid retention, hepatic or renal impairment, or CVD), comorbidi- ties, other relevant

2018 American Association of Clinical Endocrinologists

189. Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

and that psychostimulants can be effective for children 6–12 years of age. • Atomoxetine had slightly higher gastrointestinal effects than methylphenidate. • Cognitive behavioral therapy may improve ADHD symptoms among children 7–17 years of age. • Child or parent training improved ADHD symptoms among children 7–17 years of age but did not change academic performance. • Omega-3/6 supplementation made no difference in ADHD symptoms. • Future studies are needed to evaluate diagnosis, monitoring, and long-term outcomes (...) of nine possible inattentive symptoms (such as failing to give close attention to details or being easily distracted) and/or six out of nine possible hyperactivity/impulsivity symptoms (such as being “on the go” or difficulty waiting their turn). Also, symptoms need to be present for at least 6 months, occur in at least two different settings, be present before 12 years of age, and not be better explained by another disorder. For older adolescents and adults, the number of required symptoms per

2018 Effective Health Care Program (AHRQ)

190. Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

prevalence of AF is 0.4 percent to 1 percent in the general population, 2,3 occurring in about 2.2 million people in the United States. The prevalence increases to about 6 percent in people 65 years of age or older, and to 10 percent in people 80 years of age or older. 4 It is estimated that by the year 2050 there will be 12.1 million Americans with AF, representing more than a two-fold increase since 2000. However, this estimate assumes no further increase in the age-adjusted incidence of AF beyond 2000 (...) . Patients with AF have increased risk of embolic stroke, heart failure, and cognitive impairment; reduced quality of life; and higher overall mortality. 6-8 Patients with AF have a five-fold increased risk of stroke, and it is estimated that up to 25 percent of all strokes in the elderly are a consequence of AF. 4 Further, AF-related strokes are more severe than other types of stroke, with AF patients being twice as likely to become bedridden than patients with stroke from other etiologies and more

2018 Effective Health Care Program (AHRQ)

191. Homelessness at Transition

-of-home care; 17 for juvenile justice; 56 for prison; 13 for hospital, 13 for mental health; and 12 for social housing. Many of the studies included in the review do not provide direct evidence about risk factors or the effectiveness of an intervention. This is because housing outcomes were not always measured or the study population did not exactly match the population of people leaving government-funded services (e.g. all young people rather than young people aging out of care). Overall (...) Recommendation OUT-OF-HOME-CARE PATHWAY Extend age of leaving care Low • Consider trial period with an evaluation Mentoring Insufficient • Further research required before recommendation can be made Independent Living Program Low • Worthwhile supporting with adoption of a stepped-care approach Transitional housing Insufficient • Worthwhile supporting for young people with moderate- high risk of homelessness Youth Foyer model Insufficient • Not promising to pursue for OOHC young people (or Juvenile Justice

2017 Sax Institute Evidence Check

192. Wellbeing indicators across the life cycle

and Index of Wellbeing for Older People at the small area level in Australia and led the Older Adults Social Exclusion project, which was published in the journal Social Inclusion. She was a Chief Investigator for an ARC Linkage project on workforce vulnerabilities among mature-aged workers. Professor Robert Tanton has been at NATSEM since 2005 and worked on the Child Social Exclusion indexes, indexes of Wellbeing for Older Australians and the Youth Social Exclusion index. He has also attended (...) also used these as search terms. For example, a search term can be “household wealth” and “wellbeing” and “net worth” and “wellbeing”; “income” and “life satisfaction” and “income” and “wellbeing”; “older adults” and “income” and “life WELLBEING INDICATORS ACROSS THE LIFE CYCLE | SAX INSTITUTE 19 satisfaction”, where “older adults” can be replaced by “older people” or “elderly”. More detailed search terms were used in some cases. For example, “personal income” and “household income” or “income

2017 Sax Institute Evidence Check

193. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease Full Text available with Trip Pro

, and placement of a stent across the ductus arteriosus. During the second stage of palliation, a bidirection- al Glenn procedure or hemi-Fontan operation is per- formed to create a superior cavopulmonary anastomo- sis (CPA). The superior CPA is typically performed at 3 to 6 months of age and involves the anastomosis of the superior vena cava (SVC) to the pulmonary artery. After creation of the superior CPA, PBF is dependent on the SVC flow, the transpulmonary pressure gradi- ent, and vascular resistance (...) within arterial vascular beds (both cerebral and pulmonary). The third palliative op- eration, known as the modified Fontan procedure, is typically performed at 2 to 4 years of age. After Fontan completion, all systemic venous return is baffled directly to the pulmonary circulation, and the single (systemic) ventricle preload is dependent on passive flow across Table 1. Applying Classification of Recommendations and Level of Evidence A recommendation with Level of Evidence B or C does not imply

2018 American Heart Association

194. Assessment and Interventions for Perinatal Depression

this Guideline: ? Toolkit: Implementation of Best Practice Guidelines (2012) ? Developing and Sustaining Interprofessional Health Care (2013) ? Social determinants of health G (2013) ? Working with Families to Promote Safe Sleep for Infants 0 – 12 Months of Age (2014) ? Engaging Clients Who Use Substances (2015) ? Person- and Family-Centred Care (2015) ? Intra-Professional Collaborative Practices among Nurses (2016) ? Crisis Intervention for Adults Using a Trauma-Informed Approach (2017) ? Integrating (...) interventions, including non-directive counselling, for persons with perinatal depression . Ia, Ib Recommendation 2.7: Provide or facilitate access to psychotherapies, such as cognitive behavioural therapy or interpersonal therapy, for perinatal depression . Ia, Ib Recommendation 2.8: Support informed decision-making and advocate for access to pharmacological interventions for perinatal depression, as appropriate . Ia, Ib Recommendation 2.9: Facilitate informed decision-making regarding the use

2018 Registered Nurses' Association of Ontario

195. National Clinical Guideline on Adult type 1 diabetes mellitus

Institute for Health and Care Excellence (NICE) NG17 “Type 1 diabetes in adults: diagnosis and management” guideline, published in 2015. Using this National Clinical Guideline This National Clinical Guideline applies to adults (aged 18 years and older) with type 1 diabetes in Ireland. It does not apply to children living with type 1 diabetes, adults living with type 2 diabetes or individuals living with monogenic (or other rarer forms of) diabetes. This National Clinical Guideline is relevant to all (...) Groups that will be covered • Adults (aged 18 years and older) with type 1 diabetes. Groups that will not be covered • Children with type 1 diabetes. This is addressed in the HSE (2015) Model of Care for All Children and Young Adults with Type 1 Diabetes and HSE Transition from Paediatric to Young Adult Diabetes Care Guidelines (awaiting publication). • Adults with type 2 diabetes. This is addressed in the HSE (2018) Model of Integrated Care for Type 2 Diabetes (awaiting publication) and the ICGP

2018 HIQA Guidelines

196. Guidelines for the Economic Evaluation of Health Technologies in Ireland

) is an independent authority established to drive high-quality and safe care for people using our health and social care services in Ireland. HIQA’s role is to develop standards, inspect and review health and social care services and support informed decisions on how services are delivered. HIQA aims to safeguard people and improve the safety and quality of health and social care services across its full range of functions. HIQA’s mandate to date extends across a specified range of public, private and voluntary (...) . ? Monitoring Healthcare Safety and Quality – Monitoring the safety and quality of health services and investigating as necessary serious concerns about the health and welfare of people who use these services. ? Health Technology Assessment – Providing advice that enables the best outcome for people who use our health service and the best use of resources by evaluating the clinical effectiveness and cost-effectiveness of drugs, equipment, diagnostic techniques and health promotion and protection activities

2018 Health Information and Quality Authority

197. Continuous glucose monitoring (CGM real-time) and flash glucose monitoring (FGM) as personal, standalone systems in patients with diabetes mellitus treated with insulin

and women. The prevalence of peripheral vascular dis- ease in patients with diabetes aged 30 years or older is 26% [102-104]. In addition to the traditional complications described above, diabetes has been associated with increased rates of specific cancers, and increased rates of physical and cognitive disability [16]. [A0006] – What are the consequences of diabetes mellitus for the society? Diabetes mellitus and related complications have significant impact on the population level, as a serious threat (...) to population health, stability of healthcare systems, and with regard to significant economic burden [16]. According to WHO estimates, in 2014 there were 422 million adults aged over 18 years living with diabetes, resulting with a prevalence of 8.5% among the adult population. The number of people with diabetes has steadily risen over the past few decades, due to population growth, the increase in the average age of the population, and the rise in prevalence of diabetes at each age. Forty percent

2018 EUnetHTA

198. Improving the health of the public by 2040

and in the last 50 years has increased by a further 10 years for a man and 8 for a woman. 3,4 Improvements in living conditions and large reductions in infant and child mortality were major contributors to this increase in the first half of the 20th century. Over the last 50 years, improvement has been greatest at older ages. The number of people dying from coronary heart disease, for example, in Great Britain more than halved between 1961 and 2009. 5 While improved treatments have had an important role (...) and research infrastructure requirements to address these challenges and realise these opportunities? • How can we effectively train and link researchers and practitioners? • How can we ensure that the development of public policy and practice is informed by evidence (including from evaluation)? Conduct of the project The project was formally launched with a workshop that brought together a diverse mix of people to explore their aspirations for the population’s health and the drivers likely to influence

2017 Academy of Medical Sciences

199. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions

consequences but not meeting criteria for AUD. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines “risky use” as exceeding the recommended limits of 4 drinks per day (56 g/d based on the US standard of 14 g/drink) or 14 drinks per week (196 g/d) for healthy adult men aged 21 to 64 years or 3 drinks per day or 7 drinks per week (42 g/d or 98 g/week) for all adult women of any age and men 65 years or older. A standard drink is defined as 12.0 oz of beer (5% alcohol), 5.0 oz of wine (12 (...) and brief behavioral counseling interventions for unhealthy alcohol use in the primary care setting in adults 18 years or older, including pregnant women, is of moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the benefits and harms of screening for unhealthy alcohol use in the primary care setting in adolescents aged 12 to 17 years. Patient Population Under Consideration The “B” recommendation applies to adults 18 years or older, including pregnant women. The “I

2018 U.S. Preventive Services Task Force

200. Motor neurone disease: assessment and management

discussions to the person's needs, taking into account their communication ability, cognitive status and mental capacity. [new 2016] [new 2016] 1.4 Prognostic factors 1.4.1 When planning care take into account the following prognostic factors, which are associated with shorter survival if they are present at diagnosis: Speech and swallowing problems (bulbar presentation). Weight loss. Poor respiratory function. Older age. Lower Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS or ALSFRS-R (...) ] as the first-line treatment for sialorrhoea in people with MND who have cognitive impairment, because it has fewer central nervous system side effects. [new 2016] [new 2016] 1.8.14 If first-line treatment for sialorrhoea is not effective, not tolerated or contraindicated, consider referral to a specialist service for Botulinum toxin A [1] . [new 2016] [new 2016] 1.8.15 If a person with MND has thick, tenacious saliva: review all current medicines, especially any treatments for sialorrhoea provide advice

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

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